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tranfusion science > transfusion reactions > Flashcards

transfusion reactions Flashcards

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1
Q

what causes an immediate hemolytic transfusion rxn?

A

ABO incompatible units
complement binding to C9 = intravascular hemolysis

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2
Q

how long until an immediate hemolytic reaction and what are the symptoms

A

immediate 1-15 mins with fevers, chills, chest pain, and hemoglobinuria
progression: low BP, shortness of breath, nausea, burning along the vein, angioedema, back pain, anxiety, DIC, death

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3
Q

what is the treatment of an immediate hemolytic

A

supportive care

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4
Q

what are other rare non ABO causes of an immediate hemolytic reaction

A

pre formed antibody in the recipient
no antibody screen or antibody is too low frequency antigen (Cw, V, Kpa)
RBC unit is antigen positive (Kidd, Kell, Rh antibodies)

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5
Q

how can we prevent an immediate hemolytic reaction?

A

CLERICAL CHECKS, ensure every product leaving the lab is AB compatible

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6
Q

what is the cause of a febrile non hemolytic reaction?

A

soluble vasoactive cytokines in the product (often plt) from WBC breakdown
HLA antibodies in patient that react with donor wbc

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7
Q

symptoms of a febrile non hemolytic

A

fever with or without chills

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8
Q

treatment of a febrile non hemolytic reaction

A

acetaminophen, rule out other fever causing reactions
universal pre-storage leukoreduction has helped reduce febrile reductions

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9
Q

what is the cause of a mild allergic (urticarial) reaction

A

mild allergic results from IgE antibodies in patient reacting with an allergen in the donor plasma (food, protein, preservative)

  • antibodies bind mast cells which release granular contents (histamine) to give symptoms of urticarial (hives) and pruritis (itching)

have mild cardiac symptoms but BP is stable

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10
Q

timing of a mild allergic reaction

A

1-45 mins start of transfusion

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11
Q

treatment of mild allergic reaction

A

antihistamines - can transfuse slowly

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12
Q

cause of a severe anaphylactic reaction

A

due to donor IgA antibodies (it is the antigen)
recipient is IgA deficient and makes anti-IgA from previous transfusions
Anti-Iga- IgA interactions leads to severe anaphylaxis
can be allergen in donor plasma but is rare (like peanuts)
IgE Mast cells degranulation

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13
Q

timing of a sever anaphylactic reaction

A

within minutes of infusion (1-15 mins) can start mild allergic and progress

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14
Q

symptoms of sever anaphylactic

A
  • urticaria, pruritis, SOB, dyspnea, low BP, hypoxemia, GI
  • smooth muscle contraction - GI, trachea, bronchi, bronchioles
  • vasodilation - drop in blood pressure
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15
Q

treatment of severe anaphylactic

A

epinephrine, antihistamines, corticosteroids, supportive therapy

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16
Q

prevention of a severe anaphylactic reaction

A

request IgA deficient products
1/1000 people are IgA deficient
wash rbc/plt units
transfuse with caution

17
Q

cause of a bacteriogenic reaction

A

bacteria in blood product from
- normal skin flora from donor arm
- transient bacteremia in donor
- contamination of product during processing/ product manipulation
- improper storage temperature

18
Q

time of bacteriogenic reaction

A

minute - hours of toxins are present / high bacterial load in the bag several days if low microbial count - depends on patient’s immune status

19
Q

storage of blood products that can cause a bacteriogenic reaction

A

platelets that are store at 20-24 degrees
red cells that can grow psychrophiles (0-25): e coli, pseudomonas, yersinia enterocolitica

20
Q

symptoms of a bacteriogenic reaction

A

fever, chills, rigors, hypotension, flushing, clammy skin, tachycardia, DIC

21
Q

treatment of a bacteriogenic reaction

A

broad spectrum antibiotics (do blood cultures aerobic and anaerobic)
culture the donor products/ empty bag if available

22
Q

what is the cause of a delayed hemolytic reaction

A

antibody formation to non ABO antigens in donor blood (Rh, Kell, Kidd, Duffy, Ss)
antibodies bind donor cells and are removed by the liver and spleen (extravascular hemolysis)

23
Q

timing of a delayed hemolytic trxn

A

2-14 days post transfusion, usually due to secondary exposure

24
Q

products of a DH trxn

A

red blood cells

25
Q

symptoms of a DH trxn

A

fevers, chills, malaise, jaundice or no symptoms

26
Q

what is the treatment of a DH trxn

A

none!
monitor Hb, bilirubin, lactate dehydrogenase, and haptoglobin

27
Q

what are the hematological tests we can test

A

hemoglobin should be increased if transfused properly
hemoglobin is either decreased or increased
increased bilirubin means increase hemolysis
increased lactate dehydrogenase
decreased haptoglobin

28
Q

why is a positive DAT important post transfusion

A

a positive DAT is significant in a delayed hemolytic reaction

29
Q

what are some other rare causes of a pos DAT post transfusion

A
  • transfusion of a passive antibody
  • transfusion if IVIg that binds non specifically to rbs
  • donor is DAT pos
30
Q

significance of the immune response curve

A

IgG antibody concentrations will increase after the secondary exposure and will bind to donor cells

31
Q

indicators of IVH

A
  • visible hemolysis present
  • hemoglobinuria
  • decreased haptoglobin
  • increased LD
32
Q

indicators of EVH

A
  • increased bilirubin
  • increased LD
  • decreased haptoglobin
  • decreased hemoglobin ( or Hb that fails to increase)
33
Q

transfusion reaction investigation procedure:

A
  • clerical check (bedside, in lab - pretransfusion req, specimen, donor bag)
  • review symptoms
  • note product transfused
  • time of transfusion to symtoms
  • volume transfused
  • check for visible hemolysis on post transfusion sample
  • perform serological testing - ABO Rh, antibody screen, DAT, XM
  • perform non serological testing - Hem or CHem
34
Q

a patient gets transfused and had an Abscr that was neg and XM that was neg, the post transfusion sample however has a neg Abscr, pos DAT, and a neg XM. what happened?

A

not enough antibody came up causing a neg Abscr
- happens closer to the beginning
eg. if anti-c present in the plasma -> will bind to donor cells in which less Ab left in plasma will be detected

35
Q

when doing a transfusion reaction these are the results of a screen, DAT and XM. what happened?
Abscr: pos
DAT: neg
XM: pos

A

starting the reaction all donor cells tagged are removed.

collection of this sample was done at a later time

36
Q

what is the delayed transfusion workup

A
  • Ab ID if screen is positive
    -perform elution on DAT pos cells
  • Ag type implicated donor segments
  • do not Ag type patient if the have been transfused in the past 3 months
  • update records
  • serologically crossmatch with implicated donor units (should be pos)
  • serologically crossmatch Ag neg donor for subsequent transfusions if XM is still valid (within 96 hours)
37
Q

what testing is done on these samples in a transfusion reaction:
pretransfusion sample
posttransfusion sample
donor segment

A

pre: clerical check, ABO Rh, Ab screen, serological crossmatch
post: clerical check, check hemolysis, ABO Rh, Ab screen, DAT, serological XM
donor: clerical check, ABO Rh, antigen type for Ab detected in pre or post sample

tranfusion science (7 decks)

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